Morton's Neuroma

Ball of foot pain shown by a red indicator on someone's foot

What is Morton's neuroma?

Morton's neuroma develops in the plantar digital nerves that run between the long bones in your foot. These nerves can become irritated from compression and friction trauma of the surrounding tissue. If this trauma is constant and repeated, it results in chronic thickening and swelling of the lining of the nerve that's located between your toes. The thickened “bulbus” in the lining of the inflamed nerve is known as a Morton's neuroma. It can unfortunately be a rather painful condition that you will feel in the ball of your foot.

Morton's neuroma commonly occurs between the third and fourth toes on your foot, however, it can occasionally appear between other toe joint spaces. 

Causes & risk factors

Tight and poor fitting footwear, especially high heels, are the main cause of Morton's neuroma. They cause the nerves in your feet to become irritated and compressed, usually from "shoving" the toes into a tapered or small toe box. High heels also have a sloping shape, which puts added pressure on the ball of your foot when worn. 

Morton's neuroma can also be caused by foot and gait abnormalities. Abnormal mobility and range of motion in your foot joints can increase the loading on the ball of your foot.

Additionally, activities that involve repetitive and increased loads to the ball of your foot, such as running or court sports can cause irritation in these nerves. 

Considering the potential causes of Morton's neuroma, there are certain factors that can increase your risk of developing the condition:

  • People over the age of 40 as they have diminished shock absorbing fat pads in the ball of their foot that degenerate and compress over time.
  • Women or people who wear high heels, especially if you wear or have worn high heels or tight fitting shoes.
  • Jobs that require long periods of standing on your feet
  • Forefoot bursitis can impinge and irritate the nerve
  • If you have Hallux abducto-valgus (bunions of big toe joint) or Tailor's bunion (bunion of little toe joint)
  • Overloading and overuse with exercise training loads
  • Walking and running patterns

    Symptoms

    Morton's neuroma commonly occurs between the third and fourth toes on your foot, however, it can occasionally appear between other toe joint spaces. If you start to experience pain on the ball of your foot, then you may have Morton's neuroma. 

    Other symptoms associated with the condition may include:

    • Sharp shooting pain in forefoot
    • Pins and needles in the ball and toes of your foot 
    • Clicking sensation in the ball of your foot 
    • Feeling of walking on a pebble
    • Inability to bear weight due to pain 
    • Localised tenderness 
    • A burning pain in the foot that can radiate towards the end of your toes
    • Stiffness in affected joints 
    • Pain with activity and daily living 
    • Limited range of motion and mobility in joints 
    • Pain when walking barefoot and wearing particular shoes, especially tight fitting shoes or high heels

    Diagnosis

    If you think you might have a neuroma, you can perform the Morton's neuroma test on yourself by squeezing the ball of your foot from the sides, firmly. If this reproduces your pain or worsens it, you may have a neuroma. 

    The signs and symptoms of Morton's neuroma closely resemble those of other forefoot (ball of your foot) conditions. Hence, it is important for one of our podiatrists to diagnose your condition and formulate a treatment pathway. 

    Our podiatrists can confirm your condition by firstly completing a physical assessment of the area and further specialised neuroma assessments. If we think that it is a neuroma, ultrasound imaging may be used to confirm the diagnosis and assess the severity of it.

    Treatment

    The first step is ensuring we reduce your pain as quickly as possible. After we have completed your assessment in the clinic, we can put together your personalised treatment plan that allows you to achieve the fastest and most effective recovery. 

    Your plan will usually have a combination of the following treatments:

    • The RICE protocol - rest, ice, compression & elevation
    • Wearing appropriate, supportive footwear with cushioning soles, that accommodate the width of your feet
    • Strengthening and stretching exercises in conjunction with foot mobilisation techniques (FMT).
    • Adapt and modify your training program
    • Custom prescribed foot orthotics may be recommended to offload the sore, painful neuroma by increasing the spaces between irritating traumatic structures.
    • Foot and ankle strapping
    • Shockwave therapy to accelerate the healing process
    • Dry needling of surrounding soft tissues structures

    If your pain persists, our podiatrists may recommend one of the following more invasive treatments:

    • Anti-inflammatory medications
    • Corticosteroid injection
    • Surgical removal

        Our podiatrists will also recommend long term measures to decrease your chance of recurrence. This would include suggestions for appropriate fitting footwear. 

        What can happen if I ignore Morton's neuroma?

        • You may experience a chronic, prolonged healing process 
        • Forefoot bursitis can simultaneously occur due to impingement and irritation of the parallel nerves
        • Altered walking and running patterns that may result in a secondary injury
        • You may require surgical intervention or an injection into the neuroma and surrounding tissues

        Prevention

        To initially prevent Moreton's neuroma, or prevent recurrence of the condition, the following factors may help to reduce your risk:

        • Avoid wearing tight and ill fitting shoes when possible 
        • Avoid wearing high heels often and for long periods of time
        • Choose shoes with a wider toe box that allows wiggle room for your toes and enough space to accommodate the top of your foot
        • When exercising, wear footwear with enough cushioning to help relieve the pressure on the balls of your feet

        FAQs

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